Basic Information
| Provider Information | |||||||||
| NPI: | 1194227793 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POWELL | ||||||||
| FirstName: | JARED | ||||||||
| MiddleName: | NATHANIEL | ||||||||
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| Credential: | CSW, MSW, JD | ||||||||
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| Mailing Information | |||||||||
| Address1: | COMPREHENSIVE PSYCHOLOGICAL SERVICES | ||||||||
| Address2: | 1208 3300 S | ||||||||
| City: | MILLCREEK | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014831600 | ||||||||
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| Practice Location | |||||||||
| Address1: | FIRST STEP HOUSE | ||||||||
| Address2: | 440 S 500 E | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841022705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013598862 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2018 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 10239101-3502 | UT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.